ChecklistGuro Claims Reserve Management Workflow
Streamline your insurance operations with our automated Claims Reserve Management Workflow. Optimize accuracy, reduce leakage, and ensure regulatory compliance through real-time monitoring of loss reserves, automated adequacy checks, and seamless adjuster approvals. Master your financial stability by eliminating manual errors and accelerating the claims lifecycle from notification to settlement.
Start
Start of the Workflow/Process.
1. Fetch New Claim Details
Retrieve the initial claim entry and associated incident data from the Claims Data Model.
2. Retrieve Historical Reserve Data
Get previous reserve entries for the same claim ID to identify changes in reserve amounts.
3. Calculate Reserve Variance
Calculate the difference between the new proposed reserve and the current existing reserve.
4. Sum Total Outstanding Reserves
Aggregate all open reserve entries across the portfolio to calculate total financial exposure.
5. Assign Claims Adjuster Review
Create a task for the assigned Claims Adjuster to validate the new reserve amount.
6. Update Claim Status to 'Under Review'
Update the main Claim entry status to reflect that a reserve change is being processed.
7. Manager Approval Task
If the variance exceeds a specific threshold, create an approval task for the Claims Manager.
8. Create Reserve Transaction Record
Create a new entry in the Reserve Transactions data model to log the new amount.
9. Update Master Claim Record
Update the total 'Incurred Amount' on the main Claim entry to include the new reserve.
10. Notify Adjuster of Approval
Send an email to the Adjuster confirming the reserve change has been approved and processed.
11. Notify Stakeholders of High-Value Change
Send an email to the Finance Department for any reserve updates exceeding the high-value threshold.
12. Generate Monthly Reserve Report
Create a summary report of all reserve movements processed during this period.
13. Cleanup Temporary Calculation Logs
Delete temporary data entries used for intermediate calculation steps during the workflow.
14. Urgent Alert to Manager
Send an SMS to the Claims Manager if a reserve increase is flagged as 'Critical' or 'Urgent'.
End
End of the Workflow/Process.
Start of the Workflow/Process.
Retrieve the initial claim entry and associated incident data from the Claims Data Model.
Get previous reserve entries for the same claim ID to identify changes in reserve amounts.
Calculate the difference between the new proposed reserve and the current existing reserve.
Aggregate all open reserve entries across the portfolio to calculate total financial exposure.
Create a task for the assigned Claims Adjuster to validate the new reserve amount.
Update the main Claim entry status to reflect that a reserve change is being processed.
If the variance exceeds a specific threshold, create an approval task for the Claims Manager.
Create a new entry in the Reserve Transactions data model to log the new amount.
Update the total 'Incurred Amount' on the main Claim entry to include the new reserve.
Send an email to the Adjuster confirming the reserve change has been approved and processed.
Send an email to the Finance Department for any reserve updates exceeding the high-value threshold.
Create a summary report of all reserve movements processed during this period.
Delete temporary data entries used for intermediate calculation steps during the workflow.
Send an SMS to the Claims Manager if a reserve increase is flagged as 'Critical' or 'Urgent'.
End of the Workflow/Process.
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